Treating All of the Patient
Feature 22 | Physio Matters is a member magazine of Physiotherapy New Zealand
Interview by Rhonwyn Newson
David Kopacz, author of the book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine, defines a holistic approach to healthcare means taking into account all human dimensions that influence health and illness.
These include not just the physical, but also the emotional, relational, mental, creative and spiritual dimensions of the person.
“To be holistic is the opposite of being reductionist. In addition to focussing on the physical body, we also are heartcentred, bringing caring and compassion to our work,” Dr Kopacz says.
How can physiotherapists provide a more holistic approach to treating patients?
Dr Kopacz believes clinicians can only provide holistic healthcare by first developing one’s own ‘wholeness’.
“We cannot give to someone else what we have not first developed in ourselves. Healthcare is both an art and a science, although we often forget the art and only focus on the science. If we want to give more compassionate care, we must cultivate our own compassion.”
‘Counter-curriculum of self-care’
Dr Kopacz notes that healthcare workers are often not trained to take care of themselves.
“If we do not care for and replenish ourselves, we end up with professional burn-out, which leads to a loss of caring in healthcare, and ultimately a loss of health for both the healthcare worker and the client.”
The basics are a great place to start – stretching, exercise, regular movement and engagement in life. Proper nutrition and relaxation techniques are helpful too. From there, the concept of mind-body-spirit should be looked at, and this applies to both the clinician and the patient.
According to Dr Kopacz, there are nine dimensions that need to be looked at:
How can a person engage their body for health?
How can a person engage their emotions for health?
How can a person engage their mind for health?
How can a person engage their heart for health?
How can a person engage their creativity for health?
How can a person engage their intuition for health?
How can a person engage their spirit for health?
How can a person engage their context and surroundings for health?
How can a person engage their time for health?
Looking at these nine dimensions gives a holistic view of a person, and each dimension has health benefits. Physiotherapists can individualise a treatment plan by finding out how to support a person to engage all of the dimensions of their health. “We don’t have to be an expert at working with each of these different dimensions, but as healthcare workers, we need to have basic fluency in each dimension.”
Treating more than just an injury
“When people are injured or have a movement disorder, it doesn’t just affect the physical body as a machine – the body also ‘thinks’,” Dr Sandra Bassett, senior lecturer in Physiotherapy at AUT says.
Dr Bassett believes a biopsychosocial healthcare approach means taking into account the beliefs people have about their treatment and their injury.
“It means taking the time to talk to a patient about any limitations to adhering to treatments – what their time and social commitments are.”
From Dr Bassett’s perspective biopsychosocial healthcare is different to providing holistic healthcare.
“It’s about finding out and respecting what a patient thinks. What their commitments are, and how they think their bodies work.”
She also believes patient education is so important. Knowing how the body works, and how treatment will help, means patients are more likely to adhere to their treatment and manage their disability.
“I often hear physios saying, ‘But I’m not a counsellor’, and that’s true,” she says. “However, physiotherapists are well-placed to connect with people, and get them to think about their day and when they might be able to fit in their treatment exercise regime, for example.”
Physios can also place responsibility on a patient to encourage self-efficacy. “Our research shows that when patients take responsibility and ownership of their treatment, they cope much better. Patients feel better about themselves and think more positively.” In this sense, the physiotherapist may act as more of a coach by setting goals, and providing encouragement and support, as well as educating the patient.
Dr Kopacz says an injured person may also suffer from grief over lost physical functionality, anxiety over being re-injured, and even depression around an injury. These emotional and mental elements need to be addressed in order for a person to even have the motivation, and commitment, to doing the exercises that physiotherapists know would help them.
“A key question is asking a patient, ‘What do you want your health for?’ This helps to motivate a person, and individualise their care. It’s not enough to provide information or appeal to a person’s intellect. We need to focus on engendering hope as much as providing an evidence-based physical treatment,” he says.
Although this may seem like a lot to take on in a busy clinical setting, it is a vital component of providing care.
“…really, it comes down to making sure that we are good human beings to each other as well as being a good technician or clinician. Kindness and caring only take a moment and we need to make sure that we make space for that moment to occur.”